Factors for change in maternal and perinatal audit systems in Dar es Salaam hospitals, Tanzania

<p>Abstract</p> <p>Background</p> <p>Effective maternal and perinatal audits are associated with improved quality of care and reduction of severe adverse outcome. Although audits at the level of care were formally introduced in Tanzania around 25 years ago, little information is available about their existence, performance, and practical barriers to their implementation. This study assessed the structure, process and impacts of maternal and perinatal death audit systems in clinical practice and presents a detailed account on how they could be improved.</p> <p>Methods</p> <p>A cross sectional descriptive study was conducted in eight major hospitals in Dar es Salaam in January 2009. An in-depth interview guide was used for 29 health managers and members of the audit committees to investigate the existence, structure, process and outcome of such audits in clinical practice. A semi-structured questionnaire was used to interview 30 health care providers in the maternity wards to assess their awareness, attitude and practice towards audit systems. The 2007 institutional pregnancy outcome records were reviewed.</p> <p>Results</p> <p>Overall hospital based maternal mortality ratio was 218/100,000 live births (range: 0 - 385) and perinatal mortality rate was 44/1000 births (range: 17 - 147). Maternal and perinatal audit systems existed only in 4 and 3 hospitals respectively, and key decision makers did not take part in audit committees. Sixty percent of care providers were not aware of even a single action which had ever been implemented in their hospitals because of audit recommendations. There were neither records of the key decision points, action plan, nor regular analysis of the audit reports in any of the facilities where such audit systems existed.</p> <p>Conclusions</p> <p>Maternal and perinatal audit systems in these institutions are poorly established in structure and process; and are less effective to improve the quality of care. Fundamental changes are urgently needed for successful audit systems in these institutions.</p

Acceptability of medical male circumcision among traidtionally non circumcising tribes attending health care services in Makambako hospital, Njombe, Tanzania.

Background: Male circumcision (MC) can reduce men’s risk of contracting Sexually Transmitted Infections (STIs) including HIV/AIDS for at least 50% or even as high as 66%. With this regard, WHO and UNAIDS urge international community to scaled-up MC among uncircumcised men especially in HIV hard hit regions. Residents of Makambako mainly the Bena Kinga do not have a circumcision custom.Objectives: This study examined acceptability of MC among traditionally non-circumcising males accessing health care in Makambako Hospital, Njombe Region, Tanzania.Methods: This was a quantitative descriptive cross-sectional study. Some 118 uncircumcised males were randomly selected to participate. In addition, 9 health care workers (HCW) and 8 community members were purposively recruited to participate in a qualitative survey. Kiswahili semi-structured questionnaires were administered to the uncircumcised males, and Focus Group Discussions (FGDs) were held with both HCWs and Community members.Results: About 70 % uncircumcised males indicated that MC is acceptable, while 97% understand the health importance of MC, signifying that MC is gradually gaining acceptance in the study population. Majority (84%) preferred medical circumcisers over traditional ones due to safety procedure. Data from FGD revealed readiness to undergoMC, and both HCW and Community members urged for reduced costs for such services. Recommendations: For sustainability of MC scaling–up, health education should be a permanent agenda to reach the uncircumcised individuals in Njombe District.KEY WORDS: Acceptability, sexually transmitted diseases, male circumcision scale-u

Utilization of Health Care Services for STD Treatment in Kahe Community of Kilimanjaro Region in Tanzania.

A population based survey set to find out the existence of Sexually Transmitted Diseases (STDs) and use of health care services among residents of Oria village in Kahe ward of Kilimanjaro region in northern Tanzania in 1997. A few of the STDs symptoms covered were history of painful micturation (dysuria), urethral discharge and genital ulcer(s). This was a cross-sectional study using quantitative data collection technique in which a total of 898 villagers were interviewed. Findings revealed that in the past 223 (25.4%) had dysuria, 69 (7.7%) had urethral discharge while 28 (3.1%) had genital ulcer. At the time of the interview, 88 (9.8%) people had dysuria, 29 (3.2%) had urethral discharge and 9 (1.0%) had genital ulcer. Health care was sought from different sources, mostly from modern health care especially government health facilities (HFs) followed by private HFs and less so to pharmacies and traditional healers. No significant differences were found between the proportions of respondents that pertained to the different demographic variables with regard to utilization of the different health services. However, it is doubtful as to whether people treat themselves adequately since among those currently having STDs symptoms, some had previous history of treatment for the same problems. This may be due to either inadequate treatment, re-infection from untreated partners or new infections. A real explanation ought to be explored through future studies. Meanwhile, there is need to re-direct the existing strategies in addressing STDs in Oria village. The increasing demand for STDs management requires an increase in the number of HFs both private and public that have skilled health workers, the necessary supplies and drugs. Special efforts be made to target high risk groups using different health education packages on STDs and reinforce contact tracing while alternative sources of health care need to be explored further

Management of severely ill children at first-level health facilities in sub-Saharan Africa when referral is difficult

OBJECTIVES: To quantify the main reasons for referral of infants and children from first-level health facilities to referral hospitals in sub-Saharan Africa and to determine what further supplies, equipment, and legal empowerment might be needed to manage such children when referral is difficult. METHODS: In an observational study at first-level health facilities in Uganda, the United Republic of Tanzania, and Niger, over 3-5 months, we prospectively documented the diagnoses and severity of diseases in children using the standardized Integrated Management of Childhood Illness (IMCI) guidelines. We reviewed the facilities for supplies and equipment and examined the legal constraints of health personnel working at these facilities. FINDINGS: We studied 7195 children aged 2-59 months, of whom 691 (9.6%) were classified under a severe IMCI classification that required urgent referral to a hospital. Overall, 226 children had general danger signs, 292 had severe pneumonia or very severe disease, 104 were severely dehydrated, 31 had severe persistent diarrhoea, 207 were severely malnourished, and 98 had severe anaemia. Considerably more ill were 415 young infants aged one week to two months: nearly three-quarters of these required referral. Legal constraints and a lack of simple equipment (suction pumps, nebulizers, and oxygen concentrators) and supplies (nasogastric tubes and 50% glucose) could prevent health workers from dealing more appropriately with sick children when referral was not possible. CONCLUSION: When referral is difficult or impossible, some additional supplies and equipment, as well as provision of simple guidelines, may improve management of seriously ill infants and children

Dataset: Tathmini GBV study: Evaluation of comprehensive gender-based violence programming delivered through the HIV program platform in Tanzania

The Tathmini GBV study was a cluster randomized trial to assess the impact of a comprehensive health facility- and community-based program delivered through the HIV/AIDS program platform on reduction in gender-based violence and improved care for survivors. The study demonstrated the feasibility and impact of integrating gender-based violence and HIV programming to combat both of these major public health problems. Further opportunities to scale out GBV prevention and response strategies within HIV/AIDS service delivery platforms should be pursued

Cluster randomized trial of comprehensive gender-based violence programming delivered through the HIV/AIDS program platform in Mbeya Region, Tanzania: Tathmini GBV study.

The Tathmini GBV study was a cluster randomized trial to assess the impact of a comprehensive health facility- and community-based program delivered through the HIV/AIDS program platform on reduction in gender-based violence and improved care for survivors. Twelve health facilities and surrounding communities in the Mbeya Region of Tanzania were randomly assigned to intervention or control arms. Population-level effects were measured through two cross-sectional household surveys of women ages 15-49, at baseline (n = 1,299) and at 28 months following program scale-out (n = 1,250). Delivery of gender-based violence services was assessed through routine recording in health facility registers. Generalized linear mixed effects models and analysis of variance were used to test intervention effects on population and facility outcomes, respectively. At baseline, 52 percent of women reported experience of recent intimate partner violence. The odds of reporting experience of this violence decreased by 29 percent from baseline to follow-up in the absence of the intervention (time effect OR = 0.71, 95% CI: 0.57-0.89). While the intervention contributed an additional 15 percent reduction, the effect was not statistically significant. The program, however, was found to contribute to positive, community-wide changes including less tolerance for certain forms of violence, more gender equitable norms, better knowledge about gender-based violence, and increased community actions to address violence. The program also led to increased utilization of gender-based violence services at health facilities. Nearly three times as many client visits for gender-based violence were recorded at intervention (N = 1,427) compared to control (N = 489) facilities over a 16-month period. These visits were more likely to include provision of an HIV test (55.3% vs. 19.6%, p = .002). The study demonstrated the feasibility and impact of integrating gender-based violence and HIV programming to combat both of these major public health problems. Further opportunities to scale out GBV prevention and response strategies within HIV/AIDS service delivery platforms should be pursued. Trial Registration: Pan African Clinical Trials Registry No. PACTR201802003124149

Tathmini GBV study: Evaluation of comprehensive gender-based violence programming delivered through the HIV program platform in Tanzania

The Tathmini GBV study was a cluster randomized trial to assess the impact of a comprehensive health facility- and community-based program delivered through the HIV/AIDS program platform on reduction in gender-based violence and improved care for survivors. Twelve health facilities and surrounding communities in the Mbeya Region of Tanzania were randomly assigned to intervention or control arms. Population-level effects were measured through two cross-sectional household surveys of women ages 15–49, at baseline (n=1,299) and at 28 months following program scale-out (n=1,250). Delivery of gender-based violence services was assessed through routine recording in health facility registers. Generalized linear mixed effects models and analysis of variance were used to test intervention effects on population and facility outcomes, respectively. At baseline, 52 percent of women reported an experience of recent intimate partner violence. The odds of reporting experience of this violence decreased by 29 percent from baseline to follow-up in the absence of the intervention (time effect OR=0.71, 95% CI: 0.57–0.89). While the intervention contributed an additional 15 percent reduction, the effect was not statistically significant. The program, however, was found to contribute to positive, community-wide changes including less tolerance for certain forms of violence, more gender-equitable norms, better knowledge about gender-based violence, and increased community actions to address violence. The program also led to increased utilization of gender-based violence services at health facilities. Nearly three times as many client visits for gender-based violence were recorded at intervention (N=1,427) compared to control (N=489) facilities over a 16-month period. These visits were more likely to include the provision of an HIV test (55.3% vs. 19.6%, p=.002). The study demonstrated the feasibility and impact of integrating gender-based violence and HIV programming to combat both of these major public health problems. Further opportunities to scale out GBV prevention and response strategies within HIV/AIDS service delivery platforms should be pursued. </p